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For decades, fertility specialists have waited for the technology to catch up with the science. Since the mid 1990s, embryologists have recognized the importance of growing cells in a way that more closely mimics the human body. They learned that embryos need constant monitoring, specific nutrients, dynamic environments, and intelligent selection, but they didn’t have the technology required to act on many of these lessons.

With the rise of the Fourth Industrial Revolution, technology has taken a giant leap forward. All of the sudden, time lapse equipment, AI, and specialized 3D printing equipment, micro-engineering, and other technologies have opened up the possibility for game changing disruption of and innovation within IVF and fertility treatment.

The timing couldn’t be better. The number of patients seeking IVF continues to rise. Pent up demand for treatment brought on during the pandemic has yet to subside, and waitlists at clinics continue to grow.

Every IVF clinic is under pressure to deliver better results more rapidly. Harnessing these new technologies could result in innovations that revolutionize fertility treatment for practitioners and patients. Fertility startups are best positioned to lead the charge.

For the most part, governments aren’t focused on solving the fertility problem. To a certain extent, current IVF treatments work– even if success rates hover around 35 percent — so funding bodies haven’t dedicated resources to improving treatment with urgency despite the growing demand. The reality is that most medical research funding goes towards prevention-of-death research as opposed to creation-of-life research.

Legacy IVF companies tend to focus on treating patients and delivering results with existing infrastructure. They don’t have the capacity, resourcing, or incentives to invest hugely in R&D.

Startups, on the other hand, have creativity, flexibility, and impetus to develop drive forward innovations in IVF. They have the agility required to iterate on new products and devices, making changes and improvements in response to the feedback of end users.

Many startups have begun to harness new technologies to help patients take more ownership over their fertility experience. A variety of startups now offer at-home hormone monitoring, fertility test kits, sperm analytics, ovulation trackers, intracervical insemination devices, and wraparound supports such as counseling and personal care guides. However, far fewer have used these new technologies to develop devices that augment embryologists’ skills and improve conditions in the IVF lab.

The growing shortage of embryologists looms large in the field of IVF. The knock-on effect of the Covid-19 pandemic revealed and exacerbated a pervasive problem: we have too many IVF patients for too few embryologists, and the embryologists we have are overworked and under-resourced.

Becoming an embryologist takes years of training: the work is technically demanding. The high-stress environment of IVF clinics results in many people leaving the profession, and the number entering the profession isn’t enough to keep up with the demand for treatment.

Embryology requires excellent hand-eye coordination, precise movements, and the ability to manipulate multiple pieces of equipment simultaneously. Turning an egg into an embryo takes many steps. Most are time constrained; each one is risk prone; and a mistake has serious consequences.

To truly revolutionize IVF, fertility startups should focus on using new technologies to develop products and devices that improve the embryologist experience.

In the lab, embryologists have recently begun to use AI to assist them in monitoring embryo development and selecting the best embryo for implantation. That’s a limited application of a powerful technology. Embryo selection is important, but with the right application of AI, embryologists could automate a lot of IVF processes, reducing embryologists’ stress and the risk of human error while increasing the quality of the embryos themselves.

Consider ICSI– a IVF treatment commonly used for unexplained infertility and the only direct fertility intervention available for male infertility. It’s a complicated and labor-intensive technique. Embryologists must pipette eggs and inject sperm by gently breaking the egg’s membrane, all while handling two micro manipulators and working with an inverted microscope. The process is also time sensitive since eggs need to be returned to the incubator as soon as possible to ensure viability.

Using conventional ICSI techniques, embryologists expect to produce seven fertilized embryos from every 10 eggs collected. However, by using technology to automate parts of the ICSI process, embryologists could potentially increase that number to eight. That’s one extra embryo per IVF cycle.

One extra embryo per cycle increases the likelihood that a patient will have a successful pregnancy sooner. Decreasing the amount of cycles needed for a successful pregnancy means that clinics can treat more patients.

With automation also comes the standardization of results. Currently, embryologists perform techniques like ICSI by hand, learning from other embryologists. As a result, there’s a lot of subjectivity in embryo creation. The field has standards certification, but the level of embryologist expertise varies greatly from lab to lab.

Not all embryologists are created equal. Even when a group of chefs follows the same recipe, they don’t produce identical dishes. The same is true of embryologists. Even with established protocol, variation of skill level exists both within and between clinics.

While a lot of factors contribute to whether an IVF cycle is successful, the expertise of the embryologists undoubtedly plays a crucial role in a clinic’s success rates– rates that can vary significantly between clinics.

The demand for IVF treatment will continue to rise, and the embryologist problem isn’t going away. AI, micro-engineering, and other technologies create an opportunity to lessen the technically demanding work that embryologists face daily, relieving embryologists of stress and increasing the number of IVF patients that can be treated. By focusing on developing novel products and systems that reduce the labor-intensive facets of embryology, fertility startups can improve the work conditions of embryologists while helping to close the success rate gap between the world’s most and least successful IVF clinics.

Prof. David Gardner

Redmond Barry Distinguished Professor at the University of Melbourne, Director of Melbourne IVF, and Global Science and Industry Director at Fertilis